Abstract
Importance. Cutaneous and systemic plasmacytosis are rare conditions of unknown etiology with characteristic red-brown skin lesions and a mature polyclonal plasma cell infiltrate within the dermis. Perineural plasma cell infiltrates may be a histologic clue to the diagnosis of cutaneous plasmacytosis. Observations. Our patient had a five-year history of persistent reddish-brown plaques on the neck and trunk without systemic symptoms. Histologic examination showed dermal perivascular and perineural plasma cells with excess lambda light chain expression. Due to decreased quality of life caused by his skin lesions, he was placed on a chemotherapeutic regimen with bortezomib. Conclusions and Relevance. The patient was diagnosed with cutaneous plasmacytosis based on classic histopathology results with a recently characterized pattern of perineural involvement. Bortezomib therapy was initiated to manage his skin eruption, which has not been previously described as a treatment for this chronic condition.
Highlights
Cutaneous and systemic plasmacytosis are rare, lymphoplasmacytic disorders characterized by red-brown poorly circumscribed plaques and nodules occurring mainly on the trunk primarily in patients of Japanese descent [1, 2]
After extrapolating from cutaneous T- and B-cell malignancy data as well as other plasma cell disorder therapies, the decision was made to start bortezomib. He subsequently was put on subcutaneous bortezomib 1.3 mg/m2. His chemotherapy regimen included twice weekly injections over two weeks for Cutaneous plasmacytosis is a disorder of unknown etiology, which was first described by Yashiro as a “kind of plasmacytosis” and later redefined by Kitamura et al as “cutaneous plasmacytosis” [1, 5]
After no infectious etiologies were identified, this patient with normal IL-6 and gammaglobulin levels was diagnosed with cutaneous plasmacytosis by clinical correlation between the skin lesions and confirmatory histopathology
Summary
Cutaneous and systemic plasmacytosis are rare, lymphoplasmacytic disorders characterized by red-brown poorly circumscribed plaques and nodules occurring mainly on the trunk primarily in patients of Japanese descent [1, 2]. We present a Hispanic patient with chronic red-brown macules and plaques on the trunk where these distinctive biopsy findings supported the diagnosis of cutaneous plasmacytosis. Clinical examination revealed brownishred macules and mildly indurated plaques on his trunk (Figure 1) and pink-to-violaceous plaques with fine scale on his neck He was afebrile and had no lymphadenopathy. After extrapolating from cutaneous T- and B-cell malignancy data as well as other plasma cell disorder therapies, the decision was made to start bortezomib He subsequently was put on subcutaneous bortezomib 1.3 mg/m2. His chemotherapy regimen included twice weekly injections over two weeks for Figure 2: Abdominal biopsy highlighting dermal plasmacytes, which were evident in biopsies of the patient’s abdomen, flank, and neck (hematoxylin & eosin stain; original magnification: ×40)
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